Crossley Place

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

All wards were safe, generally clean, well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well. All wards were safe, clean, well equipped, well furnished, well maintained and fit for purpose. However, not all the facilities met infection control guidelines.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There had been no serious incidents at the service in the 12 months prior to our inspection.

All staff we spoke with knew what incidents to report and how to report them. The service had an electronic incident reporting system that was accessible to all staff. The number and severity of incidents varied each month. From June to November 2025 there had been 750 incidents of all types and severity, ranging from 107 to 153 each month. The service used a 5-point scale to rate incidents. The majority of incidents were rated as level 1 (the lowest severity) and at level 2 and 3. There had been 1 incident rated at level 4 and none at level 5 (the highest severity). The most common types of incidents were related to self-harm, violence and aggression, and health related problems.

The service was registered for the Patient Safety Incident Response Framework (PSIRF), an NHS incident reporting framework. Following any serious incidents staff had a ‘swarm huddle’. This was an NHS-recommended tool and involved staff getting together shortly after incidents to analyse what had happened and what needed to be done to reduce risk. This was a quick review of the incident that generated immediate actions, pending any further and more detailed investigation.

All incidents were discussed at the daily management meeting. This identified any gaps, and if any further action, information or investigation was required. Managers attended a daily meeting with managers from the other 7 hospitals owned by the provider across the Northwest. Pertinent information about incidents was shared at this meeting.

Staff did a detailed analysis of incidents each month, which were reviewed in the clinical governance meeting. The number and types of incidents were reviewed and themes identified. These looked at particular times or locations, and in relation to specific patients. All incidents were discussed at patient safety meetings.

Staff received feedback from investigations of incidents, both internal and external to the service. Alerts were shared across the organisation and discussed in staff meetings. Information about incidents was shared with staff at staff meetings, through email bulletins and supervision. Managers identified that since the introduction of PSIRF there had been a shift in how incidents were managed. Information was regularly shared, and it was easier to see incidents and learning across the organisation. They gave examples of incidents where a patient at another site had used an item to self-harm, and this had been shared with staff to minimise the risk of it happening here.

There was evidence that changes had been made following incidents. This included changes to how staff observed patients, and improvements to practice drills for medical emergencies.

Staff understood the duty of candour. All staff had had training about the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong. There had been 2 incidents that met the duty of candour threshold in the 12 months prior to the inspection. Managers had taken appropriate action following these incidents.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. All potential patients were assessed by the consultant psychiatrist and discussed within the multidisciplinary team. Staff spoke with potential patients about the service, and they were given the opportunity to visit when possible.

Crossley Place provided a rehabilitation service for people with mental health conditions that needed longer term support. They provided a bespoke package of care for each patient that was provided by a multidisciplinary team of staff. Staff emphasised developing patients’ skills and improving their quality of life in a way that was meaningful for the patient and went at their own pace. Many patients had long term mental health conditions, and some patients also had a personality disorder. Some patients may have had history of trauma, and staff were developing their model of care so that it was more trauma informed.

The service had 1 person on the waiting list at the time of this inspection. They did not assess any further patients until there was likely to be a bed available.

Staff planned for patients’ discharge, including good liaison with care managers and co-ordinators. Patients were admitted from across England, Wales, Scotland, Northern Ireland and the Republic of Ireland. Organisations that commissioned and oversaw each patient’s care routinely visited the service, and scrutinised the care provided. They worked with the provider to consider discharge planning for patients. Patients had a monthly multidisciplinary team meeting where their care was reviewed, and a care programme approach (CPA) meeting or equivalent to discuss their longer term needs every 6 months. Patients and their families were involved in these meetings and discussions. Moving on from the service was always discussed, even if it was not yet clear what a successful discharge would look like.

There were no patients whose discharge was delayed when they were clinically ready for discharge. Over the last 12 months there had been 2 patients whose discharge was delayed due to the provision of suitable permanent accommodation and other issues that were beyond the control of the service.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff we spoke with knew how to identify adults and children at risk of, or experiencing, significant harm. This included working in partnership with other agencies. All staff were trained in safeguarding, knew how to make a safeguarding alert or raise their concerns, and did so when required.

Safeguarding concerns were recorded on the incident management system and reviewed by managers. The service had links with the local authority safeguarding team and contacted them about potential safeguarding concerns. In the 12 months prior to the inspection there had been 10 safeguarding referrals to the local authority. These had all been closed by the local authority and no further action taken, and there had been no strategy meetings or Section 42 safeguarding investigations.

Staff kept a safeguarding tracker and produced a monthly report of any safeguarding incidents. This was discussed at the monthly clinical governance meeting. The service had a safeguarding lead. They shared information with the regional safeguarding lead, and attended quarterly regional meetings to discuss safeguarding concerns, seclusion, and long-term segregation.

Managers maintained a blanket restriction register. This was reviewed every 3 months, or more often if necessary, with staff and patients at a joint community meeting. Restrictions were individually risk assessed for each patient, and the register showed the rationale for any wider restrictions. At the time of our inspection these were related to random searches being carried out for potentially harmful items. Most areas were unrestricted, and where restrictions were imposed there was a rationale for this. Staff told us that as each patient had their own apartment, they could add or remove restrictions without impacting on other patients.

Managers monitored the service for the possibility of a ‘closed culture’ developing. The provider commissioned a ‘Culture Web’ analysis that was carried out by a psychologist, to look into the culture amongst staff at the service. The findings did not suggest there was a ‘closed’ or negative culture at Crossley Place, and were positive in terms of teamwork, prioritising patient safety, and having high clinical standards. There were recommendations for the senior management team that broadly reflected on communication and visibility, and more general recommendations around staff recognition and facilities. An action plan was developed from this which had mostly been completed at the time of the inspection. All staff had received close cultures awareness training.

Staff followed safe procedures for children visiting the service. The social work team co-ordinated visits by children and carried out risk assessments in advance and ensured the necessary safeguards were in place. Children did not go to the wards, but there were places for them to visit their relatives within the hospital.

Mental Capacity Act

Staff had a good understanding of the Mental Capacity Act. Mental Capacity Act training had been completed by 97% of staff. The provider had a policy on the Mental Capacity Act. Staff we spoke with were aware of the policy and had access to it. Staff we spoke with knew where to get advice from within the provider regarding the Mental Capacity Act.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Staff ensured the necessary legal frameworks were followed and involved the person’s family where possible, the commissioners of their care, advocates and legal bodies, and other health and social care professionals. Where best interest decisions were required for a patient’s physical health care, these would involve the care team who would be providing the treatment.

The service monitored adherence to the Mental Capacity Act through its daily management meetings and clinical governance processes.

There had been no Deprivation of Liberty Safeguards (DoLS) applications made in the 12 months prior to our inspection.

An advocate with experience of working with mental health patients visited the service every week. Staff and the advocate could signpost patients to an Independent Mental Capacity Advocate (IMCA) when required.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint and seclusion only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed 3 patient records as part of our inspection. All patient records we reviewed evidenced patients had a comprehensive risk assessment completed as part of their initial assessment, and this was reviewed regularly. Staff used the Short-Term Assessment of Risk and Treatability (START) risk assessment tool, which clearly identified risks. All patients had a care plan to keep themselves safe, or to manage risks they may present to others. Staff involved patients in care planning and risk assessment where possible. All patients had a personal behavioural support (PBS) plan which described how staff should respond to, and support them, when they were distressed. Patients had restrictions placed upon them, due to the risk this presented to themselves and others, but these were clearly documented with the rationale and how this was managed. These were routinely reviewed in the multidisciplinary team meeting.

Staff completed detailed incident forms of all restrictive interventions, a single incident may include several recorded physical interventions. During the 6 months prior to our inspection there had been 208 incidents involving at least 1 physical intervention, with 408 physical interventions in total. There had been 13 supine (face up) restraints, and 4 prone (face down) restraints, all of which had happened in the 3 months prior to our inspection. Managers and staff told us that they did not initiate prone restraints, but if this happened they would move the patient out of that position as quickly as possible. Staff told us that during physical interventions, patients were rarely taken to the floor, and pods (large bean bags) were used which provided more support for patient and staff. There had been 23 uses of rapid tranquilisation. Managers told us that the levels of restrictive interventions had increased over recent months due to changes in the acuity of the ward.

During the 6 months prior to the inspection there had been no new instances of long-term segregation (LTS), but a LTS had ended for a patient who had been in LTS for an extended period. There had been 1 episode of seclusion lasting 4 hours. Managers carried out an audit after every episode of seclusion. The audit showed that the necessary checks and safeguards had been carried out, but they had not all been recorded correctly which was followed up with staff and the records updated.

Any incidences of restrictive interventions were discussed in the daily management meeting. This included reviewing the incident report, identifying any gaps or any further investigation or action, and if any urgent action or change in risk or care plans was required. Managers also determined if referrals to the local authority safeguarding team or notifications to commissioners and regulators were required. Managers attended regional meetings to discuss seclusion, long-term segregation and safeguarding.

All staff were trained to carry out physical interventions. This included how to de-escalate and work with people in distress to reduce the need for physical interventions becoming necessary. All staff completed training, including annual updates, in reducing conflict situations and behaviours of concern.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Each patient has their own apartment which was tailored to their individual needs. Each apartment had a lounge with separate bedroom, ensuite bathroom and kitchen area. The kitchen and bathroom could be locked if they presented a risk to the patient. Fittings and furniture in communal areas and bedrooms were ligature free. Staff risk assessed each patient’s bedroom, and furniture and items were adjusted accordingly. Some patients had lots of their belongings including electrical and craft items in their rooms, but others were more minimal. This was individually risk assessed and reviewed regularly depending on the risks presented to the patient.

Each apartment had access to a small outdoor space. Patients also had access to shared communal areas including a courtyard garden and large grounds.

Staff carried out regular risk assessments of the care environment. An environmental and ligature risk assessment had been carried out. There were no potential ligature anchor points, or staff had mitigated the risks adequately. The service had maps for each area that showed the location of higher risk areas and blind spots, and where to access ligature cutters. Staff routinely carried out walkarounds of the building to check for risks, cleanliness and maintenance issues.

The ward layout allowed staff to observe all parts of ward. All patients had at least 1 member of staff allocated to them at all times. Staff had easy access to alarms and patients now had easy access to nurse call systems.

The ward complied with guidance on eliminating mixed-sex accommodation. Crossley Place was a female-only service, and all patients had their own apartment.

The seclusion room allowed clear observation and two-way communication and had toilet facilities and a clock. The seclusion suite had its own outdoor space. CCTV with live-streaming only (meaning it was not recorded) covered potential blind spots in the room. The seclusion room had anti-ligature fittings, and blinds and lighting were controlled from the outside the room.

Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly. Staff carried out weekly checks of the clinic rooms, which included medicines. Staff could quickly access equipment in the event of a medical emergency.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service now had no vacancies for nurses or health care assistants. Managers had calculated the number and grade of nurses and healthcare assistants required. There were typically 2 nurses and 10 support workers on Meadow ward during the day, and 1 or 2 nurses and 7 support workers on Orchard ward. There was one less support worker at night on each ward. An additional nurse worked at the weekend across both wards. The number of nurses and support workers matched this number on all shifts we reviewed. Managers carried out staffing reviews every day and could adjust staffing levels to take account of how busy the service was. When necessary, managers deployed agency and bank nursing staff to maintain safe staffing levels. When bank and agency staff were used, those staff were usually familiar with the service, and had received an induction.

Patients also received care and support from occupational therapists, registered practitioner psychologists, and social workers. Patients could access other health professionals when required, such as dietitians, physiotherapists, podiatrists, and speech and language therapists.

The service had processes for managing sickness and absence. Staff sickness rate for the 12 months prior to our inspection was 2.47%.

Staffing levels allowed patients to have regular one-to-one time with their named nurse. All patients were allocated at least one member of staff at all times. Staff shortages did not result in staff cancelling escorted leave or ward activities. There were enough staff to carry out physical interventions, such as observations, restraint and seclusion safely. Staff were trained to carry out these interventions.

There was adequate medical cover day and night and a doctor could attend the ward quickly in an emergency. The service had a full-time consultant psychiatrist who was the responsible clinician or equivalent for all patients. Out of hours medical support was provided by the regional out of hours cover system. The service had a practice nurse, who provided physical health care, and all patients were registered with a local GP practice. An Advanced Nurse Practitioner or GP from the practice provided an alternate face-to-face or remote session each week.

Staff had completed appropriate mandatory training. Staff were up to date with 99% of their mandatory training. The training was appropriate for the patient group using the service.

We scored the service as 2. The evidence showed some shortfalls. Not all the facilities met infection control guidelines. However, the service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Ward areas were clean, had good furnishings and were well-maintained. Cleaning records were up to date and demonstrated that the ward areas were cleaned regularly. Staff had access to cleaning materials including appropriate equipment, COSHH (Control of Substances Hazardous to Health) information, and coloured mops and buckets for different areas. Staff maintained equipment well and kept it clean.

Staff adhered to infection prevention and control (IPC) principles including handwashing. Infection control training had been completed by 97% of staff. Staff had access to handwashing sinks, personal protective equipment (PPE) such as gloves and aprons, and waste disposal. Staff carried out audits of handwashing. The most recent audit had scored 79%, and the staff involved were advised on how this could be improved.

Staff carried out cleanliness and IPC audits. The most recent full infection control audit was completed in October 2024. Meadow ward had scored 78% and Orchard ward 82%, and actions for improvement had been identified and most had been resolved. An audit of the clinic room had identified areas for improvement such as heat-sealing of floor-edges (to support easier cleaning) and the design of taps and sinks. These were not considered as needing urgent attention, but to be addressed as part of any future refurbishment. Some areas of the clinic rooms were crowded with supplies, which may make them more difficult to clean effectively.

Staff carried out routine environment walkarounds that included cleanliness, maintenance and access to PPE. These showed that the environment was generally clean, and if issues were identified these were addressed.

The service had suitable outdoor storage for general and other waste. The service had contracts for the disposal of general and clinical waste.

A communal bathroom was temporarily out of use. Legionella testing was routinely carried out in the building, and rarely used taps (such as in the bathroom) were routinely flushed to prevent standing water, which can increase the risk of Legionella developing.

Patients had access to a laundry room. Facilities were available for washing soiled laundry if required.

The service, which had large grounds, had previously had some issues with rodents which had now been addressed.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed good practice in medicines management. Medicines were transported, stored, dispensed, administered, recorded and disposed of in line with national guidance. Medicines, including controlled drugs, were stored securely. Room and fridge temperatures were routinely monitored and in the correct range. Unneeded or out of date medicines were safely disposed of. Denaturing kits (which put medicines beyond use) were used when disposing of controlled drugs.

Each patient’s medicines were routinely reviewed in their monthly multidisciplinary team meeting, and more frequently if required.

Staff reviewed the effects of medicines on patients’ physical health regularly and in line with NICE guidance. Staff carried out the necessary physical health checks for patients on specific medicines that required blood tests, electrocardiograms (ECGs), and bowel monitoring. When patients were prescribed high dose antipsychotic therapy (HDAT), which is medicines above the usual recommended limits, patients had an initiation form and the required ongoing monitoring completed. Patients on ‘as necessary’ medicines (often called PRN) had care plans in place for this and their use was routinely reviewed. All patients were detained under the Mental Health Act, or another legal framework. They had the necessary consent to treatment forms completed. Covert medicines were rarely used, but if this was considered necessary best interest procedures were followed, and there was a clear rationale and care plan for when and how this should be used.

Staff completed the Lester Tool, which is used for assessing patients cardiometabolic health and risks, particularly for people with mental health problems who are taking anti-psychotic medicines.

Staff carried out routine audits of medicines management and took action with the results. Staff carried out weekly checks of the clinic rooms, which included medicines. Prescription charts were routinely reviewed at the daily management meeting, to check if any medicines needed reviewing, if there were any gaps or errors, or if charts needed rewriting. An external pharmacy visited the service every fortnight. They logged any medicines issues on a database, which were reviewed by the service who marked off when the problem had been resolved. Medicines for patients’ mental health were usually prescribed by the consultant psychiatrist and dispensed by the external pharmacy. Medicines for patients’ physical health were usually prescribed by the GP practice and dispensed by a community pharmacy.